Eggener SE et al. (2007) Incidence of disease outside modified retroperitoneal lymph node dissection templates in clinical stage I or IIA nonseminomatous germ cell testicular cancer. J Urol 177: 937–943

Retroperitoneal lymph node dissection (RPLND) is an effective diagnostic and therapeutic procedure for low-stage, nonseminomatous germ cell tumor (NSGCT) of the testis. Various modified dissection templates have been developed that limit contralateral dissection to minimize rates of retrograde ejaculation associated with the procedure; however, there is a lack of data on postoperative recurrence of disease in sites outside these modified templates. Eggener et al. have used anatomical disease mapping to determine the incidence of NSGCT metastases outside five different modified RPLND templates.

A cohort of 500 men with clinical stage I–IIA NSGCT underwent RPLND with therapeutic intent. Anatomically labeled lymph-node samples were submitted for pathological analysis. Median follow-up after RPLND was 54 months. In the 191 patients who had pathological stage II disease, the incidence of disease in sites outside the template was 3–23%, depending on the template used. Anatomical mapping showed that if three additional regions of the right-side template (para-aortic, preaortic and right common iliac region) had been dissected, the incidence of disease outside the template could have been reduced to 2%. For the left-side template, if four additional regions (interoaortocaval, precaval, paracaval and left common iliac) had been dissected, incidence of disease outside the template could have been reduced to 3%.

To meet the dual aims of cancer control and minimization of retrograde ejaculation, the authors advocate the use of infrahilar nerve-sparing RPLND templates.